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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2202 - 16 November 2018 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F70. Tip of nose. Incidental finding in excision for nodular BCC


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My differential diagnosis is benign follicular tumorlet vs. another basal cell carcinoma. I favor follicular tumorlet because of the convoluted architecture. My understanding is that basaloid follicular hamartoma is a evenly spaced multifocal lesion in the superficial dermis, unlike what we see here. But please correct me if I am wrong...

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vincenzo

Posted (edited)

Acquired  Basaloid Follicular Hamartoma is a well known incidentale finding in skin around BCC. No BerEp4, no epithelial-stromal clefts, no mucin are more in keeping with BFH. No keratin cysts,no specialized(papillary mesenchimal body-like)stroma, no peripheral palizade make  me favor BFH over TE.  So agree with Alex. 

Edited by vincenzo

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Dr. Richard Carr

Posted

Whoops sorry for the late response. It's not BFH (i'd expect BFH to be BerEP4+ & CD10+ (epithelilial) just like BCC but have some dendritic Merkel cells on CK20).

So I thought the lesion was a mantleoma (mantle cell hyperplasia, folliculocentric basaloid proliferation and basaloid follicular hyperplasia or follicular tumourlet are probably all synonymous). I thought there was a hint of sebaceous differentiation here. 

BTW papillary mesenchymal cells are not present in either BFH or mantleoma.

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